5 questions to ask your doctor about codeine

Know more about codeine and prescription opioids.
With the use of opioid-based pain relief such as codeine quadrupling in the last decade, experts say it’s important to ask your GP the right questions.

Prescription opioids such as oxycodone account for over three-quarters (76%) of opioid overdoses in Australia, with at least a million Australians going on to misuse pharmaceutical drugs such as codeine.

Codeine is an opioid drug closely related to morphine and is derived from opium poppies. It is often prescribed to a person for acute pain, perhaps due to an accident, migraines, back pain or when leaving hospital after having a baby. However, it is highly addictive if taken repeatedly. For some people, once they start taking codeine they can’t stop and, if they try to, they experience withdrawal symptoms such as nausea, insomnia and vomiting.

After the birth of her son, Deniz Okutgen was given codeine for pain relief for when she returned home. With no family support to help with looking after her child, she relied on her medication to just ‘get on with things’. Never would she have anticipated that it would lead to dependency, serious health issues, isolation and a battle to withdraw off the very drugs she thought were helping her.

“I started taking about fifty tablets a month to manage my pain, but I kept needing more and more because the medication had stopped working as well as it first did. Being dependent on something is like quicksand. I was at my GP once a week because of health issues I didn’t know was related to my use of codeine. I thought I had diabetes, I was experiencing panic attacks, plus I was waking up and passing out. It was really scary,” says Okutgen.

Codeine: A dirty little secret

Bee Mohamed, chief executive of ScriptWise, a non-profit organisation dedicated to preventing prescription medication harms, says that Deniz’s story is sadly all too common.

About three-quarters of opioid overdose deaths in Australia are due to prescription opioids like oxycodone and codeine. To give you some perspective, more people in Australia die due to prescription opioid and sedative medication (benzodiazepine) use than road accidents. It’s a national crisis,” says Mohamed.

GP and Addiction Specialist, Dr Hester Wilson agrees and adds that many people don’t understand why certain drugs require a visit to the doctor. This was particularly evident earlier this year when over-the-counter codeine became a scheduled drug requiring a prescription from a GP.

“Many people don’t understand why certain drugs, such as codeine, require a prescription. Perhaps they think we are a ‘nanny state’ or that doctors are trying to make things difficult. However, as we learn more about certain drugs it may be discovered that they have more side effects than previously thought and it is time to re-evaluate how easily they should be available. It is all about the drug’s risk versus benefit profile and ultimately the patient’s safety,” Wilson says.

Okutgen had a similar experience, saying “I started to feel guilt and shame about the amount of medication I was taking, but when I took the medication those feelings would go away. That’s when the alarm bells started to go off in my head.  It became a dirty little secret.”

Better manage your pain

In terms of pain management, Dr Wilson suggests a good step in the right direction is asking your doctor a few simple questions if given a script for a pain medication.

  1. What are the issues or side effects of this drug?
  2. What are the risks for me as an individual?
  3. Do we really know what is going on with my pain?
  4. Can we reassess or rethink my treatment? Or, what is the best combination of treatment?
  5. Can I work out a pain management plan with you, or does it require a specialist?

Dr Wilson adds that there can also be an emotional element in relation to pain that should be considered.

“There can be a lot of different reasons why people don’t tell their GP what is really going on in relation to dependence. For those already using codeine long-term, it is important to ask yourself if you are using it for pain, or how are you finding it when you try to stop. Is it being used to manage emotional pain, difficulties in life or physical pain? If you have had a headache for a long time you should ask if the medication you are on could be making your headaches worse.”

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